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It’s weird, when I have a pulse oximeter on my finger and a blood pressure cuff on and it’s rather inflated I get electrical feeling shocks up my arm. The both have to be on the same arm. No idea what it is, probably a pinched nerve.
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Hold your breath. I've done that with a fingertip pulse oximeter I have.
In my experience you need to hold your breath for a while (like 2-3 minutes) for blood O2 to start decreasing. Certainly doable (and safe as long as you're lying down away from water) but might take some practice getting used to the discomfort. You can hyperventilate a bit before to make it easier (though never do this in any other breath holding scenario).
It’s weird, when I have a pulse oximeter on my finger and a blood pressure cuff on and it’s rather inflated I get electrical feeling shocks up my arm. The both have to be on the same arm. No idea what it is, probably a pinched nerve.
Likely ulnar nerve compression just above the elbow by the inflated blood pressure cuff. (retired M.D. here)
I see that you were an anesthesiologist, now I can finally asked this question that I’ve always wanted too! When under general anesthesia why do they put you on opioids? I read that if not people would still react to the pain? Like would the scream and cry just not know they were doing that?
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Chosen by the emergency doctors who headed the project. Sats being the more important. Those are default thresholds, but each they can be overridden per-patient. As I understand it there is a lot of communication going between emergency teams and specialists around the world and the odd pre-publication paper. This work has come out of the RMH's emergency department. Full credit goes to Dr Martin Dutch who's idea the…
What other tools did the hospital open source this year?
https://github.com/rmhcovid/screentool
And we have another project for operating drive-through testing clinics that will hopefully be published in the next few weeks. It has been shared through hospital channels but isn’t up on github yet.
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Thank you for sharing this. In the program guide it says a temperature reading of > 42 degrees or an oxygen saturation of < 90 are the thresholds for a MET call. Is there a basis for these specific values or are they general approximations?
When internal body temperatures start nearing 40 degrees celcius, there starts to be a real risk of dehydration. Anything above that starts nearing deathly levels, generally a temperature of 42 celcius will start leading to permanent brain damage and death. So uh, if a body temp is already at 42 it starts to be a bit late going to the hospital :D
The figures are actually set per-patient. But that 42 as placeholder does seem odd. There are two lower thresholds that trigger before getting to that one. But I’ll flag it with the clinician regardless. Thank you.
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Likely ulnar nerve compression just above the elbow by the inflated blood pressure cuff. (retired M.D. here)
That makes sense thanks! I see that you were an anesthesiologist, now I can finally asked this question that I’ve always wanted too! When under general anesthesia why do they put you on opioids? I read that if not people would still react to the pain? Like would the scream and cry just not know they were doing that?
Over my 38 years in practice (1977-2015) and some 25,000-30,000 cases, probably 95% were GA and the remainder regional/I.V. sedation.
Of the GA's, I estimate I used IV opioids in 95%. My drug of choice was fentanyl: fast and relatively short acting, easily titrated to response.
Along with fentanyl, I routinely used diazepam or Versed (I started in 1977 and Versed didn't become available until 1985), and skeletal muscle relaxants for endotracheal intubation and skeletal immobility.
Induction of GA was with sodium thiopental (1977-1989), thereafter Propofol.
Having said that, know that by the time I retired, I was in a small minority of anesthesiologists (most older like myself) who trained when balanced anesthesia was standard.
Today an overwhelming majority of anesthesiologists use only inhalation agents for GA and do not give opioids intraop. Inhalation GA often does not require skeletal muscle relaxants (depending on the surgical site), and if a patient is "light," they will react by moving and show increases in heart rate and blood pressure.
Diff'rent strokes.
FWIW, I am one of very few anesthesiologists with extended time in practice who have never been sued.
>Like would they scream and cry, just not know they were doing that?
Awareness under anesthesia is a whole different subject of considerable importance.
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In my experience you need to hold your breath for a while (like 2-3 minutes) for blood O2 to start decreasing. Certainly doable (and safe as long as you're lying down away from water) but might take some practice getting used to the discomfort. You can hyperventilate a bit before to make it easier (though never do this in any other breath holding scenario).
If you weren't doing this already, try holding your breath after exhaling to reduce the amount of oxygen stored in your lungs, then the wait wouldn't be as long - 2-3 minutes is a good breath hold!
Actually I just tried it and yeah for me at least the full-lungs version is obviously longer but takes less discomfort for my SpO2 to start to drop (like well before contractions start), whereas on exhale I get more discomfort (around 15s before contractions) before a similar drop.
It's always interesting to me how much of a hivemind the internet has and how many coincidences there are. Just last night I dug out my cheapo pulse oximeter and checked everyone in my house to get a baseline. I then googled how they work and read pretty much the same thing.
This is more a function of how many people read HN than anything else. On a population that large in a crowd of technically inclined people there's bound to be somebody who in the space of 24 hours researched how oximeters work. I read the same article a few months ago.
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Mine doesn’t drop much during exercise.
Define much, please. I believe getting near 90% at rest means it's time to think about an ER visit.
For those of us living near sea level, temporary drops below 90% should be ok if you are otherwise healthy (up to a certain point of course), because as someone else in the thread suggested, they will rebound to >=95% as soon as you return to rest/normal breathing.
(Disclaimer: I'm not a medical expert, but have had to study breathing a fair amount. Happy to have corrections from anyone with more knowledge on this!)
I measured myself at home in Mexico City and got 93%. I got kind of worried, knowing people sick with COVID-19 can have very low saturation levels without realising it. Then I remembered I was standing at about 2200 m above sea level. Lots of unexpected weirdness happens at high altutude
I’ll be honest, a lot if the portable oxygen saturation monitors seem to report slightly out of range readings. It often picks up after a few minutes, I suspect they are calibrated poorly tbh. 94-98% is the desired range.